General Surgery Coding Alert
CPT® 2020:
Prep For Musculoskeletal Code Additions
Look for drug-delivery device additions. We're rounding up all the procedure-code changes... Read more
Prep For Musculoskeletal Code Additions
Look for drug-delivery device additions. We're rounding up all the procedure-code changes... Read more
Hemorrhoidectomy:
Change How You Report Internal Hemorrhoid Excision in CPT® 2020
Master code addition and revisions. CPT® 2020 delivers some changes you need to know for... Read more
Change How You Report Internal Hemorrhoid Excision in CPT® 2020
Master code addition and revisions. CPT® 2020 delivers some changes you need to know for... Read more
Category III:
Don't Miss CPT® 2020 'Temporary' Code Additions
Learn tumor ablation options. Maybe you're quick to check the first four CPT® surgery se... Read more
Don't Miss CPT® 2020 'Temporary' Code Additions
Learn tumor ablation options. Maybe you're quick to check the first four CPT® surgery se... Read more
MIPS:
Find Out These 2020 QPP Updates
Look for reduced specialty-specific measures. You can expect administrative relief under ... Read more
Find Out These 2020 QPP Updates
Look for reduced specialty-specific measures. You can expect administrative relief under ... Read more
Reader Question:
Use Path Report or History for Dx
Question: The op note states that a patient undergoing a lumpectomy has a history of DCIS.... Read more
Use Path Report or History for Dx
Question: The op note states that a patient undergoing a lumpectomy has a history of DCIS.... Read more
Reader Question:
Check Payers for Polypectomy Bundling Rules
Question: Our surgeon performed a colonoscopy and a hot-forceps polyp excision. The op not... Read more
Check Payers for Polypectomy Bundling Rules
Question: Our surgeon performed a colonoscopy and a hot-forceps polyp excision. The op not... Read more
Reader Question:
Focus 'Medical Necessity' for Billing
Question: Sometimes we get denials for a procedure our surgeon performed due to lack of �... Read more
Focus 'Medical Necessity' for Billing
Question: Sometimes we get denials for a procedure our surgeon performed due to lack of �... Read more
Reader Question:
Code Suspected Wound Infection
Question: A patient returned to our surgeon's office following a hernia procedure complain... Read more
Code Suspected Wound Infection
Question: A patient returned to our surgeon's office following a hernia procedure complain... Read more
You Be the Coder:
Measure Lesion and Excision For Proper Coding
Question: The surgeon “creates an elliptical excision 7 cm long surrounding a 2.0 x 1.5 ... Read more
Measure Lesion and Excision For Proper Coding
Question: The surgeon “creates an elliptical excision 7 cm long surrounding a 2.0 x 1.5 ... Read more
CPT® 2020:
Check Out Integumentary Section Changes
Grab liposuction grafting upgrade. When your surgeon performs a fat graft for conditions ... Read more
Check Out Integumentary Section Changes
Grab liposuction grafting upgrade. When your surgeon performs a fat graft for conditions ... Read more
Evaluation and Management:
Get More from CPT® 2020 E/M Code Changes
Make sure time is on your side. You just might need to revamp your templates or other tim... Read more
Get More from CPT® 2020 E/M Code Changes
Make sure time is on your side. You just might need to revamp your templates or other tim... Read more
More CPT® 2020 Changes:
Catch Time Change for Virtual QNHP Non-Face-To-Face Codes
Revisions mirror physician E/M changes. If your surgical practice engages qualified non-p... Read more
Catch Time Change for Virtual QNHP Non-Face-To-Face Codes
Revisions mirror physician E/M changes. If your surgical practice engages qualified non-p... Read more
News You Can Use:
Prepare for MFA Protection With Medicare Provider Online Enrollment
Your MAC can be your guide. Hacking danger to your general surgery practice is not going ... Read more
Prepare for MFA Protection With Medicare Provider Online Enrollment
Your MAC can be your guide. Hacking danger to your general surgery practice is not going ... Read more
Reader Question:
Identify Esophageal Section
Question: What is the correct diagnosis code for a malignant lesion in the “abdominal es... Read more
Identify Esophageal Section
Question: What is the correct diagnosis code for a malignant lesion in the “abdominal es... Read more
Reader Question:
Know Who Gets No-Show Bill
Question: We've established a policy for billing no-shows, and we report 99199 to payers f... Read more
Know Who Gets No-Show Bill
Question: We've established a policy for billing no-shows, and we report 99199 to payers f... Read more
Reader Question:
Update Documentation for Med-Student Work
Question: We have a medical student working with us at our clinic. In patient encounters, ... Read more
Update Documentation for Med-Student Work
Question: We have a medical student working with us at our clinic. In patient encounters, ... Read more
Reader Question:
Use Encryption to Protect ePHI
Question: How can we make sure encryption is part of our HIPAA compliance? Codify Subscri... Read more
Use Encryption to Protect ePHI
Question: How can we make sure encryption is part of our HIPAA compliance? Codify Subscri... Read more
You Be the Coder:
Capture 2-Site Marker Placement
Question: Our surgeon performed percutaneous placement of metallic pellets using stereotac... Read more
Capture 2-Site Marker Placement
Question: Our surgeon performed percutaneous placement of metallic pellets using stereotac... Read more
Wound Repair:
From Closure to Cleaning – Details Drive Code Choice
Notice adhesive strip exclusion. Don't be fooled by the adage that wound repair coding si... Read more
From Closure to Cleaning – Details Drive Code Choice
Notice adhesive strip exclusion. Don't be fooled by the adage that wound repair coding si... Read more
E/M:
Capture Pay When Visit Time Runs Long
Follow 3 expert tips for prolonged service. Complex surgery case, records review, counsel... Read more
Capture Pay When Visit Time Runs Long
Follow 3 expert tips for prolonged service. Complex surgery case, records review, counsel... Read more
Medicare Rules:
Avoid Fraud and Abuse Charges
Unbundling is still a trap. Don't think your practice is immune from Medicare fraud and a... Read more
Avoid Fraud and Abuse Charges
Unbundling is still a trap. Don't think your practice is immune from Medicare fraud and a... Read more
Reader Question:
Symptoms May Lead New Dx Choice
Question: The surgeon performs a diagnostic laparoscopy for a patient who has undergone pa... Read more
Symptoms May Lead New Dx Choice
Question: The surgeon performs a diagnostic laparoscopy for a patient who has undergone pa... Read more
Reader Question:
Find Truth About Password Changes
Question: Our IT consultant suggests that we update passwords every 30 days, but this is m... Read more
Find Truth About Password Changes
Question: Our IT consultant suggests that we update passwords every 30 days, but this is m... Read more
Reader Question:
Check Modifier 25 Opportunity
Question: Our surgeon examined a patient in the office who had a head laceration. After th... Read more
Check Modifier 25 Opportunity
Question: Our surgeon examined a patient in the office who had a head laceration. After th... Read more
You Be the Coder:
Master Endoscopic Stent Placement Coding
Question: How should I code a transendoscopic duodenal stent placement? Iowa Subscri... Read more
Master Endoscopic Stent Placement Coding
Question: How should I code a transendoscopic duodenal stent placement? Iowa Subscri... Read more
Case Study:
Focus Distal Pancreatectomy Coding
Find the laparoscopic solution. Although surgical treatment of pancreatic cancer often in... Read more
Focus Distal Pancreatectomy Coding
Find the laparoscopic solution. Although surgical treatment of pancreatic cancer often in... Read more
ICD-10-CM:
Check Out Surgery-Relevant 2020 Diagnosis Codes
Start using new and revised codes Oct. 1, 2019. From history of cancer to cardiovascular ... Read more
Check Out Surgery-Relevant 2020 Diagnosis Codes
Start using new and revised codes Oct. 1, 2019. From history of cancer to cardiovascular ... Read more
Compliance:
Shun Cloned Notes in Medical Record Files
Identical claims could trigger fraud audit. Even though your electronic health (medical) ... Read more
Shun Cloned Notes in Medical Record Files
Identical claims could trigger fraud audit. Even though your electronic health (medical) ... Read more
Reader Question:
Manage Large Balloon Dilation Case
Question: Our surgeon performed an EGD on a patient with achalasia, and the notes sta... Read more
Manage Large Balloon Dilation Case
Question: Our surgeon performed an EGD on a patient with achalasia, and the notes sta... Read more
Reader Question:
Note Minor BMI Changes
Question: Our surgeons perform bariatric surgery, and BMI is one of the factors consi... Read more
Note Minor BMI Changes
Question: Our surgeons perform bariatric surgery, and BMI is one of the factors consi... Read more
Reader Question:
Distinguish Open and Laparoscopic Hernia Codes
Question: Would you please clarify the coding for laparoscopic versus open hernia rep... Read more
Distinguish Open and Laparoscopic Hernia Codes
Question: Would you please clarify the coding for laparoscopic versus open hernia rep... Read more
You Be the Coder:
Focus FNA Unit of Service
Question: How should I code FNA of left thyroid lobe nodule and FNA of thyroid isthum... Read more
Focus FNA Unit of Service
Question: How should I code FNA of left thyroid lobe nodule and FNA of thyroid isthum... Read more
Case Study:
Skip 38531 for Laparoscopic Lymph Node with Hernia Repair
Focus on rules for ‘unlisted' procedures. Take a peek at the following case to garner t... Read more
Skip 38531 for Laparoscopic Lymph Node with Hernia Repair
Focus on rules for ‘unlisted' procedures. Take a peek at the following case to garner t... Read more
Modifier Mastery:
Chart These Surgical Examples for Modifier 58 Victory
Pre-planning exemplifies staged procedures. You might lose the procedure pay you deserve ... Read more
Chart These Surgical Examples for Modifier 58 Victory
Pre-planning exemplifies staged procedures. You might lose the procedure pay you deserve ... Read more
Life Support:
4 Tips Create Clean ECMO Claims
Master cannula placement codes and more. If you have surgeons who are sometimes part of a... Read more
4 Tips Create Clean ECMO Claims
Master cannula placement codes and more. If you have surgeons who are sometimes part of a... Read more
Reader Question:
Improve Your E/M Time Coding Accuracy
Question: I'm confused about coding E/M services by time. Do we have to document the ... Read more
Improve Your E/M Time Coding Accuracy
Question: I'm confused about coding E/M services by time. Do we have to document the ... Read more
Reader Question:
Include India Ink in Surgery
Question: During a colonoscopy, the surgeon used a snare to remove two polyps from differe... Read more
Include India Ink in Surgery
Question: During a colonoscopy, the surgeon used a snare to remove two polyps from differe... Read more
Reader Question:
Master Modifier 25 Tips
Question: Our surgeon saw an established patient in the office to examine a third-deg... Read more
Master Modifier 25 Tips
Question: Our surgeon saw an established patient in the office to examine a third-deg... Read more
You Be the Coder:
Distinguish 3 Anal Fistula Codes
Question: The op report describes the surgeon identifying an internal anal fistula op... Read more
Distinguish 3 Anal Fistula Codes
Question: The op report describes the surgeon identifying an internal anal fistula op... Read more
Needle Procedures:
Confusing FNA and PNB Could Cost You
Look for three distinguishing features in the op report. If you've ever looked at an op r... Read more
Confusing FNA and PNB Could Cost You
Look for three distinguishing features in the op report. If you've ever looked at an op r... Read more
E/M Coding:
Make Sure Time is on Your Side for Encounter Upgrade
‘Counseling exception' is key. When your surgeon spends time counseling a patient and c... Read more
Make Sure Time is on Your Side for Encounter Upgrade
‘Counseling exception' is key. When your surgeon spends time counseling a patient and c... Read more
MIPS:
2 Keys Unlock Audit Preparedness
Secure data for six years. Participating in the Merit-Based Incentive Payment System (... Read more
2 Keys Unlock Audit Preparedness
Secure data for six years. Participating in the Merit-Based Incentive Payment System (... Read more
Reader Question:
See What Dialysis Circuit Includes
Question: Please help me understand how to code the following case: Using fluoroscopic gui... Read more
See What Dialysis Circuit Includes
Question: Please help me understand how to code the following case: Using fluoroscopic gui... Read more
Reader Question:
Report Relevant Post-Surgical ICD-10 Codes
Question: Following a Whipple procedure involving a total pancreatectomy that our surgeo... Read more
Report Relevant Post-Surgical ICD-10 Codes
Question: Following a Whipple procedure involving a total pancreatectomy that our surgeo... Read more
Reader Question:
Beware HIPAA Compliance Claims
Question: Our office purchased encryption software that claims to be “100-percent HIPAA ... Read more
Beware HIPAA Compliance Claims
Question: Our office purchased encryption software that claims to be “100-percent HIPAA ... Read more
You Be the Coder:
Focus Undescended Testes Case
Question: Our surgeon treated an 11-month-old with bilateral undescended testes. The op re... Read more
Focus Undescended Testes Case
Question: Our surgeon treated an 11-month-old with bilateral undescended testes. The op re... Read more
Lymph Node Biopsy:
3 Expert Tips Distill Perfect 38531 Use
Don't miss bilateral pay. You've long had specific codes for open lymph node biopsies fro... Read more
3 Expert Tips Distill Perfect 38531 Use
Don't miss bilateral pay. You've long had specific codes for open lymph node biopsies fro... Read more
Bundling:
Don't Miss 'Extensive' Adhesiolysis Opportunity
Make modifier 22 your friend. What can you do when your surgeon documents an abdominal or... Read more
Don't Miss 'Extensive' Adhesiolysis Opportunity
Make modifier 22 your friend. What can you do when your surgeon documents an abdominal or... Read more
Separate E/M:
Master Modifier 25 Essentials for Better Pay
Don't conflate modifiers 57 and 25. Finding both an E/M service and a surgical procedure ... Read more
Master Modifier 25 Essentials for Better Pay
Don't conflate modifiers 57 and 25. Finding both an E/M service and a surgical procedure ... Read more
Reader Question:
Hospital Admission Leads Consult Code Choice
Question: Our surgeon saw a non-Medicare patient in the office for a consultation, and the... Read more
Hospital Admission Leads Consult Code Choice
Question: Our surgeon saw a non-Medicare patient in the office for a consultation, and the... Read more
Reader Question:
Identify Site For Line Procedure Coding
Question: I have an op report that documents a central line, arterial line, and a Swan-Gan... Read more
Identify Site For Line Procedure Coding
Question: I have an op report that documents a central line, arterial line, and a Swan-Gan... Read more
You Be the Coder:
Remember Multiple-Endoscopy Rule
Question: An endoscopic PEG tube placement procedure required some extra work, and I'm won... Read more
Remember Multiple-Endoscopy Rule
Question: An endoscopic PEG tube placement procedure required some extra work, and I'm won... Read more
Pancreas Surgery:
4 Steps Focus Whipple Code Selection
Identify approach, excisions, and resections. Surgical treatment for pancreatic cancer mi... Read more
4 Steps Focus Whipple Code Selection
Identify approach, excisions, and resections. Surgical treatment for pancreatic cancer mi... Read more
ICD-10 Essentials:
Heed Excludes1 Notes For Clean Claims
Turn to the latest Coding Clinic for clarification. Maybe you groan when you turn to an I... Read more
Heed Excludes1 Notes For Clean Claims
Turn to the latest Coding Clinic for clarification. Maybe you groan when you turn to an I... Read more
OIG Report:
Make Sure You're Ready for CMS's Audit Spotlight
Code utilization could be a problem. With a recent focus on CMS's audit-recovery success,... Read more
Make Sure You're Ready for CMS's Audit Spotlight
Code utilization could be a problem. With a recent focus on CMS's audit-recovery success,... Read more
Reader Question:
Limit +49568 to Specific Hernia Cases
Question: Can we separately bill mesh placement using code +49568 for hernia repairs? Ind... Read more
Limit +49568 to Specific Hernia Cases
Question: Can we separately bill mesh placement using code +49568 for hernia repairs? Ind... Read more
Reader Question:
Think 'A' for 'Active' Encounter
Question: Our surgeon removed sutures from a patient new to our practice who had a right-t... Read more
Think 'A' for 'Active' Encounter
Question: Our surgeon removed sutures from a patient new to our practice who had a right-t... Read more
Reader Question:
Get Your CMS Info in Podcast Form
Question: I heard CMS now has a podcast to update policy information. Is that true, and if... Read more
Get Your CMS Info in Podcast Form
Question: I heard CMS now has a podcast to update policy information. Is that true, and if... Read more
Reader Question:
Focus ICD-10 For Bladder Cancer Dx
Question: Our surgeon took a bladder biopsy using a cystoscope and in the op report, descr... Read more
Focus ICD-10 For Bladder Cancer Dx
Question: Our surgeon took a bladder biopsy using a cystoscope and in the op report, descr... Read more
You Be the Coder:
Find Lipoma Depth for Code Selection
Question: The op note states that the surgeon removed a “5 x 5.5 cm mobile lipoma” fro... Read more
Find Lipoma Depth for Code Selection
Question: The op note states that the surgeon removed a “5 x 5.5 cm mobile lipoma” fro... Read more
Endoscopy:
Rouse Your Procedure and Dx Skills for This GI Case
Biopsy changes everything. When your surgeon performs multiple endoscopies on the same da... Read more
Rouse Your Procedure and Dx Skills for This GI Case
Biopsy changes everything. When your surgeon performs multiple endoscopies on the same da... Read more
CPT® 2019:
Grapple With New Technology Options for E/M Services
Check perspective for 99451, 99452. Whether an E/M service involves internet, telephone, ... Read more
Grapple With New Technology Options for E/M Services
Check perspective for 99451, 99452. Whether an E/M service involves internet, telephone, ... Read more
Modifier Focus:
Avoid 59 Fatigue With 3 Tips
Brush up on CMS guidance. Before you use modifier 59 (Distinct procedural service) again,... Read more
Avoid 59 Fatigue With 3 Tips
Brush up on CMS guidance. Before you use modifier 59 (Distinct procedural service) again,... Read more
Reader Question:
Check Out ABN Modifier Choices
Question: We have an ABN notice for a patient's low-risk screening colonoscopy becaus... Read more
Check Out ABN Modifier Choices
Question: We have an ABN notice for a patient's low-risk screening colonoscopy becaus... Read more
Reader Question:
Know Your Nose and Throat Anatomy
Question: The op note documents that the surgeon inserted a scope through the nose to exam... Read more
Know Your Nose and Throat Anatomy
Question: The op note documents that the surgeon inserted a scope through the nose to exam... Read more
Reader Question:
Don't Miss Physician CCM Code
Question: Is there a way to report chronic care management when the physician provides the... Read more
Don't Miss Physician CCM Code
Question: Is there a way to report chronic care management when the physician provides the... Read more
You Be the Coder:
See How G0513 Can Add Up for Colonoscopy
Question: Can we use the prolonged service codes G0513 and G0514 for screening colonoscopi... Read more
See How G0513 Can Add Up for Colonoscopy
Question: Can we use the prolonged service codes G0513 and G0514 for screening colonoscopi... Read more
CCI Edits:
Navigate Surgery Bundles That Could Compromise Your Pay
Modifier indicator is key. Like most first-quarter Correct Coding Initiative (CCI) update... Read more
Navigate Surgery Bundles That Could Compromise Your Pay
Modifier indicator is key. Like most first-quarter Correct Coding Initiative (CCI) update... Read more
ICD-10 Changes:
Master Guidelines for Infection, Sepsis
Neglect sequencing rules at your peril. Each year, we rush to learn “new codes, new cod... Read more
Master Guidelines for Infection, Sepsis
Neglect sequencing rules at your peril. Each year, we rush to learn “new codes, new cod... Read more
HIPAA Compliance:
Protect Patients With New HHS Cybersecurity Guidance
Learn best practices for your needs. Along with electronic health records (EHR) and other... Read more
Protect Patients With New HHS Cybersecurity Guidance
Learn best practices for your needs. Along with electronic health records (EHR) and other... Read more
Reader Question:
Spotlight CF: 1 Factor for Medicare Fees
Question: What is the “conversion factor,” and how does it impact Medicare payme... Read more
Spotlight CF: 1 Factor for Medicare Fees
Question: What is the “conversion factor,” and how does it impact Medicare payme... Read more
Reader Question:
Look for Separate Appendectomy
Question: While performing an open gallbladder removal, the surgeon noted localized perito... Read more
Look for Separate Appendectomy
Question: While performing an open gallbladder removal, the surgeon noted localized perito... Read more
Reader Question:
Prepare for LCD Changes
Question: I heard that Medicare is changing LCDs to eliminate ICD-10 codes. Does that... Read more
Prepare for LCD Changes
Question: I heard that Medicare is changing LCDs to eliminate ICD-10 codes. Does that... Read more
You Be the Coder:
Axillary Lymphadenectomy is Total
Question: The listed procedure on the op note is “partial mastectomy,” but the su... Read more
Axillary Lymphadenectomy is Total
Question: The listed procedure on the op note is “partial mastectomy,” but the su... Read more
Case Study:
Don't Miss Hernia Pay With This Colon Resection Case
Learn rules for separate services. When your surgeon identifies and repairs a hernia in t... Read more
Don't Miss Hernia Pay With This Colon Resection Case
Learn rules for separate services. When your surgeon identifies and repairs a hernia in t... Read more
2019 Medicare Pay:
Grasp MPFS Final Rule Impact for Your General Surgery Practice
Don't miss telehealth expansion. With payment and policy changes that could impact your g... Read more
Grasp MPFS Final Rule Impact for Your General Surgery Practice
Don't miss telehealth expansion. With payment and policy changes that could impact your g... Read more
2019 Final Rule:
MPFS Staggers Rollout of E/M Overhaul
Look for documentation relief this year. CMS' 2019 Medicare Physician Fee Schedule (MPFS)... Read more
MPFS Staggers Rollout of E/M Overhaul
Look for documentation relief this year. CMS' 2019 Medicare Physician Fee Schedule (MPFS)... Read more
Reader Question:
Attend to Medicare Copays and Deductibles
Question: Must we always collect Medicare patient copays and deductibles, and how do I kno... Read more
Attend to Medicare Copays and Deductibles
Question: Must we always collect Medicare patient copays and deductibles, and how do I kno... Read more
Reader Question:
Toenail Matrix Drives Code Choice
Question: A patient presented with a big toenail that was torn almost completely away from... Read more
Toenail Matrix Drives Code Choice
Question: A patient presented with a big toenail that was torn almost completely away from... Read more
Reader Question:
Note Details Guide Hemorrhoidectomy Coding
Question: Our surgeon excised a second-degree internal hemorrhoid group due to uncontrolla... Read more
Note Details Guide Hemorrhoidectomy Coding
Question: Our surgeon excised a second-degree internal hemorrhoid group due to uncontrolla... Read more
Reader Question:
Distinguish Additional Lesion Excision Method
Question: The surgeon performed a skin wedge biopsy followed by a punch biopsy for a separ... Read more
Distinguish Additional Lesion Excision Method
Question: The surgeon performed a skin wedge biopsy followed by a punch biopsy for a separ... Read more
You Be the Coder:
Use Just One Polyp Code
Question: Please help me code this op note: Surgeon resected and retrieved an 8 mm polyp i... Read more
Use Just One Polyp Code
Question: Please help me code this op note: Surgeon resected and retrieved an 8 mm polyp i... Read more
CPT® 2019:
Master Integumentary Biopsy Code Overhaul With 4 Tips
Technique documentation leads code choice. Almost nothing is left of the skin-biopsy sect... Read more
Master Integumentary Biopsy Code Overhaul With 4 Tips
Technique documentation leads code choice. Almost nothing is left of the skin-biopsy sect... Read more
Assistant Surgeon:
Sort Out 3 Modifier Choices for Clean 'Assistant' Claims
Count on ‘80' as your work horse. However, complicated an op report might seem when you... Read more
Sort Out 3 Modifier Choices for Clean 'Assistant' Claims
Count on ‘80' as your work horse. However, complicated an op report might seem when you... Read more
Practice Management:
Duck Signature-Error Denials With These Steps
Don't lose pay over this easy compliance fix. Even a coder who's mastered CPT® and ICD-1... Read more
Duck Signature-Error Denials With These Steps
Don't lose pay over this easy compliance fix. Even a coder who's mastered CPT® and ICD-1... Read more
Reader Question:
Get Detailed for Intestinal Obstruction Dx
Question: I'm used to certain basic diagnoses that we face all the time, like intestinal o... Read more
Get Detailed for Intestinal Obstruction Dx
Question: I'm used to certain basic diagnoses that we face all the time, like intestinal o... Read more
Reader Question:
Don't Bundle E/M and X-ray
Question: An established patient reports to the surgeon reporting pain on her right side c... Read more
Don't Bundle E/M and X-ray
Question: An established patient reports to the surgeon reporting pain on her right side c... Read more
You Be the Coder:
Distinguish 36821 from 36825
Question: Surgeons in our practice sometimes create vascular access by arteriovenous fistu... Read more
Distinguish 36821 from 36825
Question: Surgeons in our practice sometimes create vascular access by arteriovenous fistu... Read more